Masaaki Konishi1, Yasushi Matsuzawa2, Toshiaki Ebina2, Masami Kosuge2, Masaomi Gohbara3, Kunihiro Nishimura4, Michikazu Nakai5, Yoshihiro Miyamoto5, Yoshihiko Saito6, Hiroyuki Tsutsui7, Issei Komuro8, Hisao Ogawa9, Kouichi Tamura10, Kazuo Kimura2. 1. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. Electronic address: m_koni@yokohama-cu.ac.jp. 2. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. 3. Division of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan. 4. Preventive Medicine and Epidemiology Informatics, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan. 5. Department of Statistics and Data Analysis, Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Osaka, Japan. 6. Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan. 7. Department Cardiovascular Medicine, Faculty of Medical Sciences, Kyusyu University, Fukuoka, Japan. 8. Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan. 9. National Cerebral and Cardiovascular Center, Osaka, Japan. 10. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Abstract
BACKGROUND: There is little evidence regarding social and geographic factors in patients with heart failure (HF). We sought to investigate the association between in-hospital mortality of patients with HF and population density of the patients' area of residence in Japan. METHODS: The present study is a retrospective cohort analysis of the nationwide claim-based database, the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). We selected data of 196,286 hospitalized patients with HF (median age of 81 years and 51.8% males). RESULTS: In-hospital mortality was 14.2%, 11.8%, and 9.5% in the lower, middle, and upper tertiles of population density, respectively. Age sub-analysis showed the largest absolute rural-urban disparity in mortality was 4.6% in the oldest subgroup (≥80 years). Multivariate analysis using mixed logistic regression model revealed that higher population density was associated with lower in-hospital mortality: multivariable-adjusted odds ratio (OR): 0.785, 95% confidence interval (CI): (0.713-0.864), p < 0.001 and 0.687, 95% CI: (0.623-0.757), p < 0.001 in the middle and upper tertiles, in comparison with the lower tertile as a reference, after adjustment for age, sex, the New York Heart Association class, comorbidities, and hospital volume. The same tendency was observed in propensity score analysis using 62,291 (in the lower vs. middle tertile) and 57,228 (in the lower vs. upper tertile) matched pairs (OR: 0.797, 95% CI: 0.725-0.877, p < 0.001 and OR: 0.695, 95% CI: 0.634-0.762, p < 0.001 in the middle and upper tertile, respectively). CONCLUSIONS: Higher population density was associated with lower in-hospital mortality in HF. More research is needed to gain insight into causality.
BACKGROUND: There is little evidence regarding social and geographic factors in patients with heart failure (HF). We sought to investigate the association between in-hospital mortality of patients with HF and population density of the patients' area of residence in Japan. METHODS: The present study is a retrospective cohort analysis of the nationwide claim-based database, the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). We selected data of 196,286 hospitalized patients with HF (median age of 81 years and 51.8% males). RESULTS: In-hospital mortality was 14.2%, 11.8%, and 9.5% in the lower, middle, and upper tertiles of population density, respectively. Age sub-analysis showed the largest absolute rural-urban disparity in mortality was 4.6% in the oldest subgroup (≥80 years). Multivariate analysis using mixed logistic regression model revealed that higher population density was associated with lower in-hospital mortality: multivariable-adjusted odds ratio (OR): 0.785, 95% confidence interval (CI): (0.713-0.864), p < 0.001 and 0.687, 95% CI: (0.623-0.757), p < 0.001 in the middle and upper tertiles, in comparison with the lower tertile as a reference, after adjustment for age, sex, the New York Heart Association class, comorbidities, and hospital volume. The same tendency was observed in propensity score analysis using 62,291 (in the lower vs. middle tertile) and 57,228 (in the lower vs. upper tertile) matched pairs (OR: 0.797, 95% CI: 0.725-0.877, p < 0.001 and OR: 0.695, 95% CI: 0.634-0.762, p < 0.001 in the middle and upper tertile, respectively). CONCLUSIONS: Higher population density was associated with lower in-hospital mortality in HF. More research is needed to gain insight into causality.
Authors: Lei Chen; Raluca Ionescu-Ittu; Hela Romdhani; Annie Guerin; Paul Kessler; Maria Borentain; Keith Friend; Mary DeSouza; Naoki Sato Journal: Cardiol Ther Date: 2021-02-20
Authors: Sebastian König; Vincent Pellissier; Johannes Leiner; Sven Hohenstein; Laura Ueberham; Andreas Meier-Hellmann; Ralf Kuhlen; Gerhard Hindricks; Andreas Bollmann Journal: Clin Cardiol Date: 2021-12-23 Impact factor: 2.882